A Splenic Abscess in a Trauma Setting: A Case Report and Comprehensive Literature Review

A splenic abscess is rare after trauma, and it has been reported with high mortality rates. Treatment options include antibiotics, percutaneous pigtail drain, or surgical intervention; however, there are no specific guidelines for the treatment of splenic abscesses in trauma settings. We report a 69-year-old male who came in with a splenic abscess after angioembolisation for a splenic laceration after having a right hemicolectomy. Our case presents new information and current recommendations for the management of splenic abscesses based on a comprehensive literature review.

VanSonnenberg et al. found that intraabdominal abscesses can be treated in various ways, with a single mature abscess cured in up to 80-90% of patients [6].Patients who have undergone percutaneous drainage may avoid surgery [6].Treatment options include broad-spectrum antibiotics and percutaneous drainage [7].In one-third of cases, splenectomy and laparotomy are necessary, especially in trauma settings [6].Risk factors for failure and complications include age, injury grade, presence of a pseudoaneurysm, and traumatic injuries.
Percutaneous drains can serve as a bridge to surgery for critically ill patients with multiple comorbidities [8], but they carry risks such as bleeding, organ damage [9], and colonic damage [10], which must be carefully considered.

Case Presentation
A 69-year-old man with a history of deep vein thrombosis, peripheral vascular disease, and hypertension was evaluated in the emergency room four months after a right-sided hemicolectomy for invasive, lowgrade ascending colon adenocarcinoma.He presented with upper abdominal pain and vomiting.Radiological tests revealed a large splenic hemorrhage with a large volume of hemoperitoneum.He also had a small bowel obstruction with a transition point in the right iliac fossa.
Initially, he was treated with distal embolization of the peripheral branch, and the bowel obstruction was resolved and discharged.Three weeks after admission, he presented with left upper quadrant pain, leucocytosis, and fever.A CT scan revealed a large 200-mm walled-off collection/hematoma with scattered gas locules, a very small left basal pleural effusion, and mild atelectasis (Figure 1).

FIGURE 1: CT abdomen showing gas locules in the large splenic hematoma
A decision was made for percutaneous drainage insertion, and a 12 Fr Dawson Mueller drainage catheter was inserted over a guidewire.The splenic fluid MSC (Clostridium tertium) was isolated and treated with Augmentin and oral antibiotics.The percutaneous drain was kept for a month, and the drain was removed after full recovery.

Discussion
The study by Lee et al. found that 4.6% of patients with blunt trauma had intra-abdominal abscesses [11], which are often linked to splenic and liver damage [12].
The mortality rate of splenic abscesses is still high, and early detection is crucial.Fever, left upper quadrant pain, and leucocytosis are present in one-third of the cases [13].The patient had recent abdominal surgery, trauma, and angioembolization, which are risk factors for splenic abscess.The CT scan revealed a gas locule inside the splenic hematoma, making the diagnosis challenging.
Treatment options vary based on patient stability, comorbidities, and the severity of the injury.Splenectomy is the standard treatment, but antibiotics and percutaneous drainage can be successful [10].Eight point four percent (8.4%) of patients experienced minor complications such as catheter kinking, displacement, or blockage due to thick fluid, flakes, and debris [14].
According to our review of the literature, there have been 13 cases of splenic abscesses in trauma settings (Table 1), and patients may experience these abscesses 48 hours to 4 months after the trauma.In this case, multiple factors, including recent abdominal surgery and improved splenic abscess drainage, suggest that percutaneous drainage and possibly the insertion of another drain are reasonable approaches to splenic abscesses, even in trauma settings.

Conclusions
A splenic abscess in trauma settings is a rare condition that requires prompt diagnosis and intervention.There is no gold standard for treatment, and management options should be tailored to each patient.Percutaneous drainage with one or two drains is a feasible option.
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TABLE 1 :
large area within the spleen of low attenuation, with a thin, air-filled, fistulous tract between the gastric lumen and the splenic cavity.The transabdominal US of the spleen revealed no septation.III splenic laceration with active extravasation, repeat CT within 48 h splenic necrosis with significant amounts of air within the splenic parenchyma and splenic fossa.pole of the spleen demonstrated liquefaction with rupture through the lateral capsule and hyperdense layering and fluid tracking along the diaphragm, paracolic gutter, and pelvis suspicious for subacute hemorrhage with superimposed infection.Moderate left hydroureteronephrosis without an obstructing lesion consistent with chronic ureteropelvic junction obstruction was also identified.sustained fractures of the Ramus pubis and transverse process of the fifth lumbar vertebrae as well as a grade 1 tear of the spleen then another CT showed a splenic abscess and a small amount of free Review of the literature for splenic abscesses after trauma